Emergency care physicians spend their days making critical decisions, including whether to admit patients into hospital beds or discharge them.
Medically urgent cases are admitted to the hospital for emergency care, but the majority of patients visiting the Emergency Department (ED) – more than 85% – are discharged.
Many patients are referred for follow-up outpatient care for a wide range of reasons from wound checks to specialist evaluation. For patient safety reasons, discharges need to be thorough, but the process takes up time and staff resources. Premature, poorly planned, or delayed discharges have consequences.
Improving the discharge process is a key goal for EDs. When optimized, ED discharging improves patient flow, helps to reduce crowding, and prevents patient returns.
Text messaging is being hailed as a viable, low-cost communication strategy that can improve the discharge process. This blog explains how.
What is the discharge process in EDs?
When any patient leaves a hospital ED, they go through a discharge process. Many patients will have ongoing care needs, so a discharge plan is necessary to set out the next steps of care.
A discharge summary includes the reason for ED visit, diagnosis/findings, procedures, test, and treatment involved, the patient’s condition on discharge, active issues, medications, and any instructions (including follow-up care).
The broad functions of the discharge process include communication, education, and coordination of future care. Poor discharge planning can lead to poor health outcomes and delayed discharge can cause patients to remain in the ED longer than necessary. This impacts patient flow, which can lead to crowding and can leave patients feeling dissatisfied.
How text messaging can improve ED discharging
- Timely and safe discharge from EDs involves the following:
- Effective communication
- Alignment of services to ensure continuity of care
- Efficient workflow systems and processes to support discharge
- Clear discharge plans
Texting is a low-cost, low-effort way of keeping in touch with patients and sharing important health-related information.
97% of Americans now own a mobile phone and SMS messaging is the most popular form of digital communication.
Eliminate post-ED phone calls
Nurses spend a lot of time calling patients following their visits to ED. Not only is it a labour-intensive job, but also many people don’t accept calls from unrecognized numbers and may not listen to a voicemail message, making results less than satisfactory.
Reduce patient stress
ED visits are typically unexpected and anxiety-provoking, which makes it difficult for patients to focus on discharge instructions. Research shows that patients scoring high in hospital stress tend to report more pain during their visit and experience less improvement after discharge than those patients scoring low in hospital stress.
Text messaging during an ED visit can keep patients and families informed of ED wait times, share diagnostic testing wait times and directions, and let patients know when they are ready to be seen. Keeping patients informed via text can reduce stress and increase staff efficiency.
Improve attendance at post ED follow-ups
A successful ED discharge isn’t just about the timely movement of patients out of emergency care. Engagement in follow-up treatment is also vital to prevent any return visits to ED. Patients miss post-emergency follow-up appointments for a variety of reasons, from insurance status to childcare, work commitments, and transportation barriers. But many patients miss appointments simply through forgetfulness.
Interventions, such as phone calls, to improve post-ED follow-up care are labour intensive. Texting is proving a highly successful alternative.
A randomized controlled trial of ED patients with outpatient follow-up visits scheduled at the time of ED discharge found that automated text message appointment reminders resulted in improvement in attendance.
Another study on the use of texting for adolescents who had visited the ED with Pelvic Inflammatory Disease (PID) also found that personalized text message reminders were efficacious in improving follow-up attendance.
Reduce ED return visits
When patients have fully understood their discharge plan, they are more likely to comply. Simple text messages to remind patients of any follow-up appointment, confirm medication protocols, offer support and advice about who to contact if symptoms change, and what to look out for, can all help to prevent an unnecessary return to the ED.
With PatientTrak, for example, simple pro-active support beyond the ED visit can be delivered via automated texts according to pre-defined criteria.
This can include health tips, provider service information and medication reminders, all of which provide additional support to prevent a patient landing back at square one.
Studies show that patients contacted by text after an ED visit are less likely to revisit the ED and more likely to contact their primary care provider.
How the discharge process affects outcomes
Completing a patient discharge in EDs is fraught with challenges. Patients can feel highly stressed and unable to take in information.
Staff are working in a highly charged and distracting environment with time pressures. Poor discharge planning has consequences for patient compliance and health outcomes.
Research shows that patients who do not have enough information about their discharge have decreased treatment compliance, decreased patient safety, increased ED recidivism*, and poor satisfaction.
*ED recidivism is defined as patients returning to the ED for care within a designated time period following an initial ED visit.
A patient’s understanding of discharge instructions also has potential repercussions. If a patient doesn’t understand why they are being discharged and what they need to do next, they are much more likely to return to ED, miss future care appointments, and fail to comply with medication instructions.
Interestingly, a study on ED discharge compliance found that despite the patients’ high stated levels of satisfaction with communication in the ED, more than half of patients failed to comply with important discharge information.
Poor discharging can also lead to subsequent inpatient admission – a costly and preventable outcome. Ultimately, patient health and provider reputation are at stake.
Text messaging can help to reduce patient stress during an ED visit, making it easier for them to assimilate discharge information.
Discharge plans can be shared by HIPAA-compliant text messages so patients have a simple, easy-to-read plan they can easily refer back to. Post-ED calls can be eliminated and replaced by a series of texts offering bite-sized next steps.
Keeping patients on the right path with PatientTrak
Informed, engaged patients have better care experiences, better health outcomes and higher satisfaction rates. That’s why having software that makes patient engagement effortless is a worthwhile investment.
Monitor patient flow, identify bottlenecks, harvest data for predictive analysis, and send automated appointment reminders. Send text messages in a flash to patients, family members and staff to keep everyone in the loop about the next steps and care progression.
Save time and resources in your ED discharging process with PatientTrak. Get in touch and we’ll show you how.